The pharmaceutical industry has its problems, but the multi-billion-dollar supplement industry does too. At least pharmaceuticals have to prove effectiveness and pass rigorous safety and quality tests. Supplements, on the other hand, don’t have to prove effectiveness, and are poorly regulated (what regulations there are depend in large part on the honor system). Hidden drugs in supplements are one problem, and today’s column provides some examples.

Male sexual enhancement supplements:  Nutrition Action, published by the Center for Science in the Public Interest, had an article a few years ago titled “Are there hidden drugs in your supplements?” We’ve all seen ads in newspapers and magazines promoting supplements with “natural formulas” that claim to help with “energy, libido, and sexual performance.” Between 2007 and 2016, the FDA found 746 supplements that contained hidden drugs, and nearly half were products for male sexual enhancement. These hidden ingredients were Viagra-like drugs, many of which had never been tested for safety or effectiveness. The article included the following quote from Pieter Cohen, an associate professor of medicine at Harvard Medical School, who researches supplement safety: “A combination of consumer demand and unscrupulous manufacturers has created a huge market for dangerous sexual enhancement supplements.”

Weight-loss supplements are another offender. Some contain sibutramine, an appetite suppressant that’s no longer allowed in prescription drugs due to increased risk of heart attacks and strokes. Other weight-loss supplements have potentially dangerous amphetamine-like stimulants.

Muscle-building and sports supplements:  Muscle-building supplements sometimes contain dangerous steroid and steroid-like compounds. Some supplements marketed as enhancing sports performance contain problematic amphetamine-like stimulants. In 2004 the FDA banned ephedra, due to safety concerns, but supplement companies started adding ephedra-like compounds, with unproven safety records.

Following are some take-home messages about supplements:

• Just because a product is “natural,” doesn’t mean it’s safe (e.g. arsenic and lead are natural).
• You can’t be sure what’s really in many supplements. For example, a 2017 study of melatonin supplements promoted for sleep found that the amount of melatonin in the product often didn’t match what was listed on the label.
• The benefits that supplement manufacturers claim for their products are usually unproven in human studies.
• Humans evolved to get nutrients through their food, not supplements.
• Especially if you eat fruit, vegetables, legumes, whole grains, nuts and seeds every day most supplements are rarely helpful and can be harmful.
• Beware of health care providers who sell supplements (how can they be unbiased?).
• There’s no reliable system like there is with pharmaceuticals to determine if supplements are harming people.
• The law should be changed so that before putting a product on the market, it would have to be proven in human studies to be effective. The law should also require that the FDA and consumers can tell exactly what’s in a supplement—in easy-to-understand language.
• Unfortunately, the supplement industry has undue influence in Washington, so don’t expect needed changes in the law to occur any time soon.

Caveats

• If you’re on a strict plant-based diet, or if you eat animal products and are over 50, you need to take a daily B12 supplement. B12 is made by bacteria in dirt, and with treated water and pre-washed produce we don’t eat much dirt these days. Animals eat dirt and B12 is stored in their muscle, but If you’re over 50 and eat meat you may not absorb enough B12.
• Over the millions of years the human genome was developing, early humans were living in equatorial Africa mainly naked, absorbing a lot of direct sunlight, resulting in vitamin D levels of 100 or more. Most Americans fail to achieve the U.S. standard of 30, so we need to be taking D3 daily.
• Some would argue that if you don’t eat seafood, you should consider an algae-derived omega-3 supplement, although omega-3 can be obtained through a handful of walnuts and tablespoon of flax meal daily.
• Folic acid during pregnancy has been shown to help prevent neural tube defects in the fetus, so pregnant women should be taking a supplement that contains this.
•  And although it’s fairly easy for vegans to get enough zinc, iodine, and selenium in their diet another option is to take Dr. Fuhrman’s trustworthy men’s or women’s supplement daily. Note that salt is fortified with iodine but we should be avoiding salt.

Dr. Greg Feinsinger is a retired family physician who started the non-profit Center For Prevention and Treatment of Disease Through Nutrition. For questions or to schedule a free consultation about nutrition or heart attack prevention contact him at gfmd41@gmail.com or 970-379-5718.